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Parcel 014-1075-60-000 10/12/2006 03:40 PM
PAGE 1 OF 1
Alt. Parcel 35.31.15.564A 014 - TOWN OF FOREST
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - MILLER, ROGER A & SUSAN M
ROGER A & SUSAN M MILLER
3025 HWY 64
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 2198 GLENWOOD CITY
SP 1700 WITC
it
Legal Description: Acres: 39.000 Plat: N/A-NOT AVAILABLE
SEC 35 T31N R1 5W NW NW EXC 1 ACRE IN NW Block/Condo Bldg:
CORNER & EXC THE E 330' OF N 660'& INC
(564C) 014-1075-70-001 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
35-31N-15W NW NW
Notes: Parcel History:
Date Doc # Vol/Page Type
02/09/1999 5975036 1402/422 WD
10/01/1997 566170 1267/257 WD
12/10/1979 363225 609/357 LC
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 11/11/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 30,000 140,300 170,300 NO
AGRICULTURAL G4 25.000 3,800 0 3,800 NO
UNDEVELOPED G5 4.000 1,000 0 1,000 NO
PRODUCTIVE FORST LANDS G6 5.000 9,000 0 9,000 NO
Totals for 2006:
General Property 39.000 43,800 140,300 184,100
Woodland 0.000 0 0
Totals for 2005:
General Property 39.000 43,800 140,300 184,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 014-1075-70-001 10/12/2006 03:41 PM
PAGE 1 OF 1
Alt. Parcel 35.31.15.564C 014 - TOWN OF FOREST
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - MILLER, ROGER A & SUSAN M
ROGER A & SUSAN M MILLER
3025 HWY 64
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 3025 HWY 64
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 35 T31N R1 5W PT NW NW THE E 330' OF Block/Condo Bldg:
N 660' (5AC) ASS'D/W 014-1075-60 (564A)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
35-31 N-1 5W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/09/1999 597503 1402/422 WD
07/23/1997 609/357
2006 SUMMARY Bill Fair Market Value: Assessed with:
0 014-1075-60-000
Valuations: Last Changed: 07/14/1999
Description Class Acres Land Improve Total State Reason
Totals for 2006:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2005:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 12104/1998 Batch PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
Kr~L'R_f TOWNSHIP b,~-SEC. Sy T~LN, R l -W
0. ADDRESS-A-Z ;j
ST. CROIX COUNTY, WISCONSIN.
.'BDIVISION LOT LOT SIZE
PLAN VIEW +
-Distances S dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /
+
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j ► + i i i ;
,r I + j ' - - ' -
+ ± i !Indicate North Arrow
j I I SCALE . '
t,PTIC TAIr'K(S) MFGR. CONCRETE STEEL fj~
NO. of rings on cover / Depth DRY TELL
+NCHES NO. of width _ length area
no. of lines Y? width length 7j- area,'
depth; to top of pipe
aGREGATE ? y f c , r~ .
"t K RATE AREA REQUIRED ' AREA AS BUILT
C,sclaimer: The inspection of this system by St. Croix County does not imply complete
,09liance with State Administrative Codes. There are other areas that it is not possible
,p inspect at this point of construction. St. Croix County assumes no liability for
ystem operation. However, if failure is noted the County will make every effort to
,itermine cause of failure.
AEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
'-INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER /~j
r
z
REPORT OF INSPECTIJN INDIVIDUAL SEWAGE SYSTEM
San.itany Penm.it
State Septic
NAME- i ownzh.ip - St. Cno.ix County
Location Section
SEPTIC TANK
Size r gatton.b. Numb en o6 Compantmentb j
Di6tance Fnom: Wett bt. 12% on greaten stope 6t
Su.itd.ing 6t. Wettandz 6t.
Highwaten -
DISPOSAL SYSTEM
D.iatance Fnom: Wett 6t. 12% on greaten s.tope 6t.
Bu.itd.ing 6t. Wettand,6 Ft.
• H.ighwaten St.
FIELD DIMENSIONS:
Width o6 trench 6t. Depth o6 rock below t.ite .in.
Length o6 each tine 6t. Depth o6 rock oven t.ite in.
Number o6 tines Depth o6 t.ite below grade .in.
Totat .length o4 tineA St. S.tope o6 trench in pen 100 6t.
Di4tance between .Q..ina 6t. Depth to bedrock 6t.
Totat abz onbt.ion anew jt2 Depth to gnoundwaten 6t.
-Requited area 6t2 Type of Coven: Papers on Straw
PIT DIMENSIONS:
Number o6 p.itz Ghavet around pits ye.a no
Outa.ide d.iameten 6t. Depth below .inQet St.
2
Totat abzonbt,ion area 5t A
3Z
Area nequined 6t2 m
INSPECTED BY TITLE
APPROVED DATE 197._.
REJECTED DATE 197.
I
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EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: k?'/4,A1,W'114, Section,:;h ,TIZN, R fir) W, Township orb{ F~/ c'-S r
Lot No. , Block No. County /CSC
Subdivis on Name
Owner's Name: o4e ,+Yi /q
Mailing Address: a~ wv~
TYPE OF OCCUPANCY: Residence X No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE SC .67 •i0ev, -
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P 1
P r - r
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B_ yes Vc,
No "61 _r Z .,s e-
7 rY > 7. r's
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the locationand square feet of suitable areas. Indicate number of qu a feet of absorption area
needed for building type and occupancy. yfQ ,AdApl ~.e+7. / t t*= - Indicate scale
or distances. Give horizontal and vertical reference points. Indicate ope.
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct
to the best of my knowledge and belief.
Name (print) (5:4,4e M ~ Certification No.
Address E"L e N a, e o ~ i f Y 14, Z
Name of installer if known f!•L 5 /Nl ~H
COPY A -LOCAL AUTHORITY CST Signature
i.
State and County State Permit #
rwml B 6 7
Permit Application County Perm #
- for Private Domestic Sewage Systems County
'DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: 7W Section --55 , T N, R (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: 'Commercial "Industrial _'Other (specify) 'Variance
Single family y~ Duplex No. of Bedrooms _j No. of Persons
D- SEPTIC TANK CAPACITY/et7j Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete _ Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Ra P' S Total Absorb Area J-2 f 5 sq. ft.
New A Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: ~5,6.Length- /o y Width --12, Depth- 24- Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- 7" ~2,;;, Distance from critical slope
WATER SUPPLY: Private KI Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME S►~~L~ C.S.T. # r~ 7 and other information
obtained from (owner/builder).
Plumber's Signature # Phone # MP/MPRSW ZS/~ _ 5 ~_J
Plumber's Address o
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
C- - U~
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State Count Date
Permit Issued/PhqetTM (date) Issuing Agent Name
Inspection Yes4-N o State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4, plumber (canary copy)
Revised Date 7/1 /78